BEHAVIORAL EFFECT OF OBSTRUCTIVE SLEEP APNEA IN CHILDREN

腺扁桃体切除术(AT)仍然是儿童最常见的外科手术之一，但近年来AT的适应症发生了变化。现在，外科医生在许多情况下对可疑的阻塞性睡眠呼吸障碍(SDB)进行AT，有时还会对可能是SDB后果的日间行为，特别是注意力不集中和多动症进行AT。然而，SDB是否导致了这些和其他破坏性行为，这些行为的确切性质，以及SDB可能是什么类型或级别的问题，都不是很清楚。如果没有这样的知识，儿科医生和耳鼻喉科医生通常不会利用客观的术前测试来帮助评估SDB或异常行为。这项研究的主要目的是：(1)更好地确定接受AT的儿童是否经常出现注意力不集中和多动；(2)确定表明这些行为的SDB的测量和水平；(3)检验AT后SDB的改善是否与行为的改善有关；(4)调查SDB是某些儿童注意力不集中、多动和相关行为的原因的假设。受试者为5至12岁的儿童，在医生安排他们接受AT(n=200)或疝修补术(n=75)后招募。手术前将使用一系列经过充分验证的行为评估工具、认知测试和结构化的精神病学访谈，以确定哪些行为在接受AT而不是腹股沟修补的儿童中更突出。所有儿童都将接受术前多导睡眠监测，这将是此类系列中的第一次，该设备可以检测出可能在儿童中特别普遍的微小形式的SDB。结果将允许确定哪些多导睡眠图发现与明确的不良行为结果相关。最后，这些受试者的术前和术后测试将为SDB提供一项对照的非随机试验，证明AT后SDB相关的异常行为是否得到改善，并为SDB是否是这些行为的原因提供强有力的证据。

Adenotonsillectomy (AT) remains one of the most common surgical procedures performed in children, but indications for AT have changed in recent years. Surgeons now perform AT in many instances for suspected obstructive sleep-disordered breathing (SDB), and sometimes for daytime behaviors that may be a consequence of SDB, especially inattention and hyperactivity. However, whether SDB causes these and other disruptive behaviors, the precise nature of these behaviors, and what types or levels of SDB may be of concern are not well known. Without such knowledge, pediatricians and otolaryngologists do not often make use of objective preoperative testing that could help to assess for SDB or abnormal behavior. The main goals of the research described in this proposal are to (1) better define whether inattention and hyperactivity are frequent among children who undergo AT, (2) identify measures and levels of SDB that are indicative of these behaviors, (3) test whether improvement in SDB after AT is associated with improvement in behavior, and (4) investigate the hypothesis that SDB is a cause of inattention, hyperactivity, and related behaviors in some children. Subjects will be 5 through 12 year-old children recruited after they have been scheduled by their physicians for AT (n = 200) or hernia repair (n = 75 controls). A battery of well-validated behavioral assessment tools, cognitive tests, and structured psychiatric interviews will be used before surgery to define what behaviors are more prominent in the children scheduled for AT rather than hernia repair. All children will undergo preoperative polysomnography which will include, for the first time in such a series, equipment that can detect subtle forms of SDB which may be particularly prevalent in children. Results will allow determination of what polysomnographic findings are associated with well-defined adverse behavioral outcomes. Finally, preoperative and postoperative testing in these subjects will provide a controlled non-randomized trial of AT for SDB, demonstrate whether SDB-associated abnormal behaviors improve after AT, and provide strong evidence for whether SDB is a cause of these behaviors.